Provider First Line Business Practice Location Address:
1565 ROUTE 507
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18426-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-676-4276
Provider Business Practice Location Address Fax Number:
570-969-9697
Provider Enumeration Date:
03/28/2007