Provider First Line Business Practice Location Address:
100 N ACADEMY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17822-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-271-6164
Provider Business Practice Location Address Fax Number:
570-271-6141
Provider Enumeration Date:
02/22/2006