Provider First Line Business Practice Location Address:
616 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
JIM THORPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18229-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-325-2289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2006