Provider First Line Business Practice Location Address:
9 SASSAFRAS MEW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARIEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-689-2132
Provider Business Practice Location Address Fax Number:
866-592-5338
Provider Enumeration Date:
05/13/2009