Provider First Line Business Practice Location Address:
345 E CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740-6979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-873-3440
Provider Business Practice Location Address Fax Number:
570-873-3572
Provider Enumeration Date:
01/23/2006