Provider First Line Business Practice Location Address:
RR 3 BOX 3161A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYLORSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18353-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-992-2550
Provider Business Practice Location Address Fax Number:
570-992-2550
Provider Enumeration Date:
08/10/2006