Provider First Line Business Practice Location Address:
1039 ONEILL HWY
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:
18512-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-963-0977
Provider Business Practice Location Address Fax Number:
570-963-7708
Provider Enumeration Date:
04/27/2012