Provider First Line Business Practice Location Address:
300 COMMUNITY DR STE E
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-8992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-9880
Provider Business Practice Location Address Fax Number:
570-839-9885
Provider Enumeration Date:
04/10/2006