Provider First Line Business Practice Location Address:
HC 1 BOX 2014
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:
18372-9095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-629-4921
Provider Business Practice Location Address Fax Number:
570-629-9221
Provider Enumeration Date:
02/15/2007