Provider First Line Business Practice Location Address:
15 MEADE ST
Provider Second Line Business Practice Location Address:
SUITE L3
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-723-2855
Provider Business Practice Location Address Fax Number:
570-723-2877
Provider Enumeration Date:
03/10/2006