Provider First Line Business Practice Location Address:
658 ROUTE 739
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HAWLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18428-6086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-775-9555
Provider Business Practice Location Address Fax Number:
570-775-9593
Provider Enumeration Date:
10/12/2006