Provider First Line Business Practice Location Address:
24 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:
18709-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-714-1444
Provider Business Practice Location Address Fax Number:
570-714-1488
Provider Enumeration Date:
03/09/2006