Provider First Line Business Practice Location Address:
317 LUZERNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18643-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-899-6837
Provider Business Practice Location Address Fax Number:
570-654-7414
Provider Enumeration Date:
11/09/2021