Provider First Line Business Practice Location Address:
80 HIGH SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18801-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-6219
Provider Business Practice Location Address Fax Number:
570-278-4798
Provider Enumeration Date:
05/19/2006