Provider First Line Business Practice Location Address:
121 MOOSIC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518-2082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-8434
Provider Business Practice Location Address Fax Number:
570-299-2521
Provider Enumeration Date:
08/22/2024