Provider First Line Business Practice Location Address:
24 CEMETERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPWALLOPEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18660-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-239-8197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2019