Provider First Line Business Practice Location Address:
RT 611
Provider Second Line Business Practice Location Address:
TANNERSVILLE PLAZA
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-619-5142
Provider Business Practice Location Address Fax Number:
570-619-0127
Provider Enumeration Date:
06/27/2007