Provider First Line Business Practice Location Address:
408 SCOTRUN AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTRUN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18355-9663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-688-2929
Provider Business Practice Location Address Fax Number:
570-688-0022
Provider Enumeration Date:
12/21/2006