Provider First Line Business Practice Location Address:
1424 JEFFERSON 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:
18509-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-218-5711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2025