Provider First Line Business Practice Location Address:
521 ASH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-2244
Provider Business Practice Location Address Fax Number:
570-344-1226
Provider Enumeration Date:
06/19/2012