Provider First Line Business Practice Location Address:
633B LAKESIDE 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:
18466-9792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-7771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2008