Provider First Line Business Practice Location Address:
28 E TIOGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-2084
Provider Business Practice Location Address Fax Number:
570-836-7876
Provider Enumeration Date:
10/17/2006