Provider First Line Business Practice Location Address:
RR 2 BOX 514
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNKLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18058-9658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-234-6564
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2008