Provider First Line Business Practice Location Address: 
200 DELAWARE ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HONESDALE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18431-1150
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
570-253-9039
    Provider Business Practice Location Address Fax Number: 
570-253-9052
    Provider Enumeration Date: 
08/23/2006