Provider First Line Business Practice Location Address:
141 B MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-3008
Provider Business Practice Location Address Fax Number:
570-724-1992
Provider Enumeration Date:
11/07/2006