Provider First Line Business Practice Location Address:
STATE ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-0037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-3357
Provider Business Practice Location Address Fax Number:
570-746-3839
Provider Enumeration Date:
10/24/2006