Provider First Line Business Practice Location Address:
1000 MILL 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:
18512-3069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-7624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2010