Provider First Line Business Practice Location Address:
102 E. MAIN ST.
Provider Second Line Business Practice Location Address:
BOX 147
Provider Business Practice Location Address City Name:
DUSHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-928-8146
Provider Business Practice Location Address Fax Number:
570-928-7488
Provider Enumeration Date:
09/27/2013