Provider First Line Business Practice Location Address:
393 ROUTE 940
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BLAKESLEE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-646-8040
Provider Business Practice Location Address Fax Number:
570-643-9031
Provider Enumeration Date:
11/17/2014