Provider First Line Business Practice Location Address:
812 SHOEMAKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST WYOMING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18644-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-693-4020
Provider Business Practice Location Address Fax Number:
570-693-2123
Provider Enumeration Date:
11/02/2007