Provider First Line Business Practice Location Address:
586 FISCHLER STREET EXT
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:
16901-7862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-1209
Provider Business Practice Location Address Fax Number:
570-724-6636
Provider Enumeration Date:
08/15/2009