Provider First Line Business Practice Location Address:
939 MOOSIC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-471-3506
Provider Business Practice Location Address Fax Number:
570-471-3407
Provider Enumeration Date:
01/10/2006