Provider First Line Business Practice Location Address:
457 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-2185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-883-9444
Provider Business Practice Location Address Fax Number:
570-883-9333
Provider Enumeration Date:
04/20/2006