Provider First Line Business Practice Location Address:
72 MILANVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACH LAKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18405-8402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-470-6662
Provider Business Practice Location Address Fax Number:
570-300-2751
Provider Enumeration Date:
08/02/2010