Provider First Line Business Practice Location Address:
31 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-4171
Provider Business Practice Location Address Fax Number:
570-339-4955
Provider Enumeration Date:
05/15/2006