Provider First Line Business Practice Location Address:
1229 MONROE 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:
18509-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-789-7082
Provider Business Practice Location Address Fax Number:
800-801-7684
Provider Enumeration Date:
05/31/2006