Provider First Line Business Practice Location Address:
1701 FOWLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-2925
Provider Business Practice Location Address Fax Number:
570-752-3190
Provider Enumeration Date:
09/24/2010