Provider First Line Business Practice Location Address:
8616 COUNTRY PLACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-656-3660
Provider Business Practice Location Address Fax Number:
570-504-5913
Provider Enumeration Date:
01/30/2012