Provider First Line Business Practice Location Address:
1124 MEADE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18512-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-5311
Provider Business Practice Location Address Fax Number:
570-880-7651
Provider Enumeration Date:
10/15/2018