Provider First Line Business Practice Location Address:
75 SOUTH WYOMING AVENUE SUITE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-2800
Provider Business Practice Location Address Fax Number:
570-718-1481
Provider Enumeration Date:
09/26/2006