Provider First Line Business Practice Location Address:
189 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-451-2020
Provider Business Practice Location Address Fax Number:
570-451-3083
Provider Enumeration Date:
06/12/2008