Provider First Line Business Practice Location Address:
1001 N ELMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18840-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-888-2192
Provider Business Practice Location Address Fax Number:
570-888-7902
Provider Enumeration Date:
06/21/2005