Provider First Line Business Practice Location Address:
200 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18810-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-888-5805
Provider Business Practice Location Address Fax Number:
570-888-4673
Provider Enumeration Date:
10/04/2005