Provider First Line Business Practice Location Address:
2937 ROUTE 611 UNIT 15
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:
18372-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-236-8380
Provider Business Practice Location Address Fax Number:
570-355-4097
Provider Enumeration Date:
05/08/2008