Provider First Line Business Practice Location Address:
128 CONSTITUTION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JESSUP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18434-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-7311
Provider Business Practice Location Address Fax Number:
570-383-7399
Provider Enumeration Date:
09/16/2013