Provider First Line Business Practice Location Address:
130 BRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-760-1227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2009