Provider First Line Business Practice Location Address:
RR1 BOX 405 M ROUTE 390 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANADENSIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-595-9355
Provider Business Practice Location Address Fax Number:
570-595-3770
Provider Enumeration Date:
03/01/2007