Provider First Line Business Practice Location Address:
207 W GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-4100
Provider Business Practice Location Address Fax Number:
570-343-7725
Provider Enumeration Date:
07/07/2005