Provider First Line Business Practice Location Address:
101 MAIN ST UNIT D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUZERNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18709-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-274-5428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2020