Provider First Line Business Practice Location Address:
24569 ROUTE 6
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TOWANDA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18848-8254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-7688
Provider Business Practice Location Address Fax Number:
570-265-7422
Provider Enumeration Date:
06/29/2011