Provider First Line Business Practice Location Address:
RR 1 BOX 339A
Provider Second Line Business Practice Location Address:
ROUTE 106
Provider Business Practice Location Address City Name:
KINGSLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18826-9778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-434-2181
Provider Business Practice Location Address Fax Number:
570-434-2755
Provider Enumeration Date:
05/20/2006