Provider First Line Business Practice Location Address:
2901 BREWER HOLLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-7764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-1091
Provider Business Practice Location Address Fax Number:
570-746-5067
Provider Enumeration Date:
01/27/2007