Provider First Line Business Practice Location Address:
300 LYCOMING MALL CIR
Provider Second Line Business Practice Location Address:
SUITE 264
Provider Business Practice Location Address City Name:
PENNSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-8072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-546-8315
Provider Business Practice Location Address Fax Number:
570-546-0312
Provider Enumeration Date:
03/01/2007