Provider First Line Business Practice Location Address:
25 EAST 8TH STREET
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:
570-693-1164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2012