Provider First Line Business Practice Location Address:
11671 ROUTE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16901-6750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-724-2542
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006