Provider First Line Business Practice Location Address:
1456 E LACKAWANNA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYPHANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-319-2053
Provider Business Practice Location Address Fax Number:
570-591-1801
Provider Enumeration Date:
05/23/2012