Provider First Line Business Practice Location Address:
651 ROUTE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYLORSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18353-8338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-350-4475
Provider Business Practice Location Address Fax Number:
570-992-7150
Provider Enumeration Date:
11/27/2008