Provider First Line Business Practice Location Address:
RT 6 FARM AND HOME PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-746-1004
Provider Business Practice Location Address Fax Number:
570-746-9470
Provider Enumeration Date:
04/03/2007