Provider First Line Business Practice Location Address:
30 ED PREATE DR # 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-678-2588
Provider Business Practice Location Address Fax Number:
866-259-6004
Provider Enumeration Date:
10/21/2005