Provider First Line Business Practice Location Address:
101 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUZERNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18709-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-283-1331
Provider Business Practice Location Address Fax Number:
570-283-2070
Provider Enumeration Date:
08/20/2006