Provider First Line Business Practice Location Address:
120 VALLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-691-8986
Provider Business Practice Location Address Fax Number:
570-668-2691
Provider Enumeration Date:
09/27/2007