Provider First Line Business Practice Location Address:
67 BRIDGE ST
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:
18657-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-5881
Provider Business Practice Location Address Fax Number:
570-836-3081
Provider Enumeration Date:
05/12/2006