Provider First Line Business Practice Location Address:
276 ASHLER MANOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-6865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-546-6777
Provider Business Practice Location Address Fax Number:
570-546-8898
Provider Enumeration Date:
09/21/2012