Provider First Line Business Practice Location Address:
1141 CLAY AVE
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:
18510-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-5947
Provider Business Practice Location Address Fax Number:
570-558-0777
Provider Enumeration Date:
01/15/2007