Provider First Line Business Practice Location Address:
5674 ROUTE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKESLEE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18610-7926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-643-7286
Provider Business Practice Location Address Fax Number:
570-643-7292
Provider Enumeration Date:
11/27/2020