Provider First Line Business Practice Location Address:
ROUTE 307 WINOLA PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WINOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18625-2962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-378-2885
Provider Business Practice Location Address Fax Number:
570-378-2962
Provider Enumeration Date:
08/01/2006