Provider First Line Business Practice Location Address:
38 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEECH CREEK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16822-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-962-2382
Provider Business Practice Location Address Fax Number:
570-962-2333
Provider Enumeration Date:
10/15/2012