Provider First Line Business Practice Location Address:
274 SUSQUEHANNA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18644-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-709-5370
Provider Business Practice Location Address Fax Number:
570-709-5372
Provider Enumeration Date:
08/29/2012