Provider First Line Business Practice Location Address:
114 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-0174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-6003
Provider Business Practice Location Address Fax Number:
570-746-2011
Provider Enumeration Date:
11/21/2006