Provider First Line Business Practice Location Address:
1201 S MAIN ST REAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-499-4290
Provider Business Practice Location Address Fax Number:
570-457-4747
Provider Enumeration Date:
03/10/2021