Provider First Line Business Practice Location Address:
2942 ROUTE 611 STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-7924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-3342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2024