Provider First Line Business Practice Location Address:
1RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINISINK HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-420-8601
Provider Business Practice Location Address Fax Number:
570-420-0613
Provider Enumeration Date:
10/31/2006