Provider First Line Business Practice Location Address:
10932 W STATE ROUTE 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-5558
Provider Business Practice Location Address Fax Number:
570-339-5997
Provider Enumeration Date:
04/05/2006