Provider First Line Business Practice Location Address:
413 RR 1, ROUTE 611 AND OLD MILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-629-8554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2022