Provider First Line Business Practice Location Address:
144 ACADEMY 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:
18709-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-331-3522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006