Provider First Line Business Practice Location Address:
ROUTE 6, 590 PALMYRA TOWNSHIP
Provider Second Line Business Practice Location Address:
LAKE REGIONAL CENTER
Provider Business Practice Location Address City Name:
HAWLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-226-6550
Provider Business Practice Location Address Fax Number:
570-226-8571
Provider Enumeration Date:
12/01/2020