Provider First Line Business Practice Location Address:
920 WYOMING AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
FORTY FORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-3970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-3611
Provider Business Practice Location Address Fax Number:
570-283-3396
Provider Enumeration Date:
09/02/2006