Provider First Line Business Practice Location Address:
17382 STATE ROUTE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MILFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18834-7776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-465-5151
Provider Business Practice Location Address Fax Number:
570-465-5154
Provider Enumeration Date:
04/30/2008