Provider First Line Business Practice Location Address:
642 STATE ROUTE 93 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGARLOAF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18249-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-708-1505
Provider Business Practice Location Address Fax Number:
570-708-1506
Provider Enumeration Date:
06/05/2006