Provider First Line Business Practice Location Address:
246 STADDEN RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-620-4346
Provider Business Practice Location Address Fax Number:
570-620-4342
Provider Enumeration Date:
05/16/2011