Provider First Line Business Practice Location Address:
217 S BLAKELY ST
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:
18512-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2011