Provider First Line Business Practice Location Address:
RR 1 BOX 3350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18832-8740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-5755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2008