Provider First Line Business Practice Location Address:
1141 CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18510-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-1429
Provider Business Practice Location Address Fax Number:
570-963-1953
Provider Enumeration Date:
11/24/2006