Provider First Line Business Practice Location Address:
2277 STATE ROUTE 547
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18826-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-434-2104
Provider Business Practice Location Address Fax Number:
570-434-2104
Provider Enumeration Date:
12/12/2006