Provider First Line Business Practice Location Address:
2836 ROUTE 611 STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-7922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-619-5413
Provider Business Practice Location Address Fax Number:
570-619-5462
Provider Enumeration Date:
05/15/2007