Provider First Line Business Practice Location Address:
ROUTE 93
Provider Second Line Business Practice Location Address:
BOX N
Provider Business Practice Location Address City Name:
SUGARLOAF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-4444
Provider Business Practice Location Address Fax Number:
570-708-0164
Provider Enumeration Date:
08/31/2006