Provider First Line Business Practice Location Address:
12560 STATE ROUTE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17777-8525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-538-2501
Provider Business Practice Location Address Fax Number:
570-538-3227
Provider Enumeration Date:
11/07/2018