Provider First Line Business Practice Location Address: 
439 E DRINKER ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DUNMORE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18512-2483
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
570-430-7943
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/18/2016