Provider First Line Business Practice Location Address:
1330 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-5168
Provider Business Practice Location Address Fax Number:
570-383-7013
Provider Enumeration Date:
04/25/2012