Provider First Line Business Practice Location Address:
473 EASTON TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LAKE ARIEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-689-0400
Provider Business Practice Location Address Fax Number:
570-689-0600
Provider Enumeration Date:
08/13/2007