Provider First Line Business Practice Location Address:
354 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOBYHANNA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18466-7786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-894-3272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2019