Provider First Line Business Practice Location Address:
105 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-0339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-1109
Provider Business Practice Location Address Fax Number:
570-746-6006
Provider Enumeration Date:
12/12/2006