Provider First Line Business Practice Location Address:
1114 TEXAS PALMYRA HWY BOX 2
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
HONESDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-251-9336
Provider Business Practice Location Address Fax Number:
570-251-9337
Provider Enumeration Date:
03/17/2006