Provider First Line Business Practice Location Address:
813 MAIN ST FRNT UNIT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-589-2112
Provider Business Practice Location Address Fax Number:
570-589-2115
Provider Enumeration Date:
08/26/2008