Provider First Line Business Practice Location Address:
809 SR 29 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-8072
Provider Business Practice Location Address Fax Number:
570-836-8070
Provider Enumeration Date:
03/01/2010