Provider First Line Business Practice Location Address:
RR 2 BOX 2340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANADENSIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-595-6055
Provider Business Practice Location Address Fax Number:
570-595-6055
Provider Enumeration Date:
06/23/2006