Provider First Line Business Practice Location Address:
22 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-5297
Provider Business Practice Location Address Fax Number:
570-822-1512
Provider Enumeration Date:
10/04/2006