Provider First Line Business Practice Location Address:
1416 MONROE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-575-2292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2010