Provider First Line Business Practice Location Address:
214 WYOMING AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-613-9900
Provider Business Practice Location Address Fax Number:
570-613-9902
Provider Enumeration Date:
06/24/2005