Provider First Line Business Practice Location Address:
100 SUSQUEHANNA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18421-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-785-2422
Provider Business Practice Location Address Fax Number:
570-785-9557
Provider Enumeration Date:
11/29/2006