Provider First Line Business Practice Location Address:
1516 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTY FORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005