Provider First Line Business Practice Location Address:
490 NORTHAMPTON ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-8100
Provider Business Practice Location Address Fax Number:
570-288-7987
Provider Enumeration Date:
08/22/2007