Provider First Line Business Practice Location Address:
55 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-0307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-1610
Provider Business Practice Location Address Fax Number:
570-746-6218
Provider Enumeration Date:
05/22/2008