Provider First Line Business Practice Location Address:
112 N TURNPIKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18414-9131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-563-2568
Provider Business Practice Location Address Fax Number:
570-563-8289
Provider Enumeration Date:
08/30/2010