Provider First Line Business Practice Location Address:
17 MAPLE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17951-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-544-9131
Provider Business Practice Location Address Fax Number:
570-544-6412
Provider Enumeration Date:
02/03/2010