Provider First Line Business Practice Location Address:
25 WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-996-6200
Provider Business Practice Location Address Fax Number:
570-996-6201
Provider Enumeration Date:
12/05/2023