Provider First Line Business Practice Location Address:
72 GLENMAURA NATIONAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-4405
Provider Business Practice Location Address Fax Number:
570-344-4468
Provider Enumeration Date:
06/13/2011