Provider First Line Business Practice Location Address:
519 2ND ST
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:
18512-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-561-8748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2015