Provider First Line Business Practice Location Address:
5683 ROUTE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKESLEE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18610-7973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-355-7100
Provider Business Practice Location Address Fax Number:
570-420-2579
Provider Enumeration Date:
05/20/2020