Provider First Line Business Practice Location Address:
42573 ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYALUSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18853-8542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-721-3661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2026