Provider First Line Business Practice Location Address:
RR 3 BOX 5A
Provider Second Line Business Practice Location Address:
TURNPIKE STREET
Provider Business Practice Location Address City Name:
SUSQUEHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18847-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-853-4921
Provider Business Practice Location Address Fax Number:
570-853-3768
Provider Enumeration Date:
06/25/2006