Provider First Line Business Practice Location Address:
110 PLAZA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-724-4241
Provider Business Practice Location Address Fax Number:
717-703-0018
Provider Enumeration Date:
01/04/2006