Provider First Line Business Practice Location Address:
202 RTS 11&15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMMELS WHARF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-0800
Provider Business Practice Location Address Fax Number:
570-743-7113
Provider Enumeration Date:
01/29/2007