Provider First Line Business Practice Location Address:
586 EASTON TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARIEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-313-0149
Provider Business Practice Location Address Fax Number:
272-313-0147
Provider Enumeration Date:
12/18/2023