Provider First Line Business Practice Location Address:
24 PLAZA LANE
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:
16901-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-723-8720
Provider Business Practice Location Address Fax Number:
570-723-8722
Provider Enumeration Date:
02/28/2007