Provider First Line Business Practice Location Address:
RR3 BOX 3406
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYLORSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-854-3123
Provider Business Practice Location Address Fax Number:
610-799-8318
Provider Enumeration Date:
02/20/2007