Provider First Line Business Practice Location Address:
RT. 6 TOWN PLAZA
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
TUNKHANNOCK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-836-4294
Provider Business Practice Location Address Fax Number:
570-836-7709
Provider Enumeration Date:
03/21/2006