Provider First Line Business Practice Location Address:
22537 ROUTE 187
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYSOX
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18854-7742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-9788
Provider Business Practice Location Address Fax Number:
570-265-3447
Provider Enumeration Date:
07/13/2006