Provider First Line Business Practice Location Address:
82 EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-2255
Provider Business Practice Location Address Fax Number:
570-723-5110
Provider Enumeration Date:
07/06/2006