Provider First Line Business Practice Location Address:
414 E DRINKER ST REAR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18512-2469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-2050
Provider Business Practice Location Address Fax Number:
570-558-2056
Provider Enumeration Date:
07/29/2005