Provider First Line Business Practice Location Address:
521 ASH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-347-4420
Provider Business Practice Location Address Fax Number:
570-347-4732
Provider Enumeration Date:
06/02/2026