Provider First Line Business Practice Location Address:
880 SR 6 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-6149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-996-1467
Provider Business Practice Location Address Fax Number:
570-836-2339
Provider Enumeration Date:
03/30/2011