Provider First Line Business Practice Location Address:
LAKE PLAZA 2 ROUTE 706 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18801-0285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-3393
Provider Business Practice Location Address Fax Number:
570-278-1716
Provider Enumeration Date:
04/14/2006