Provider First Line Business Practice Location Address:
RR 1 BOX 1664
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIENDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18818-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-553-2078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006