Provider First Line Business Practice Location Address:
380 YORK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWANDA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-268-4096
Provider Business Practice Location Address Fax Number:
570-265-7824
Provider Enumeration Date:
07/06/2006