Provider First Line Business Practice Location Address:
2838 ROUTE 611
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-7923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-476-3336
Provider Business Practice Location Address Fax Number:
570-839-7210
Provider Enumeration Date:
06/30/2010