Provider First Line Business Practice Location Address:
62 PLAZA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-7142
Provider Business Practice Location Address Fax Number:
570-724-6771
Provider Enumeration Date:
07/13/2010