Provider First Line Business Practice Location Address:
62 INDUSTRIAL PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARIEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-689-7565
Provider Business Practice Location Address Fax Number:
570-689-4803
Provider Enumeration Date:
02/02/2010