Provider First Line Business Practice Location Address:
OLD BLUE HOUSE
Provider Second Line Business Practice Location Address:
ROUTE 6
Provider Business Practice Location Address City Name:
WYSOX
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-3993
Provider Business Practice Location Address Fax Number:
570-265-8146
Provider Enumeration Date:
09/01/2006