Provider First Line Business Practice Location Address:
241 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18644-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-693-4550
Provider Business Practice Location Address Fax Number:
570-693-3199
Provider Enumeration Date:
07/21/2006