Provider First Line Business Practice Location Address:
1504 W FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-5532
Provider Business Practice Location Address Fax Number:
570-752-5538
Provider Enumeration Date:
09/01/2005