Provider First Line Business Practice Location Address:
12 E 6TH ST
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:
18644-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-609-5385
Provider Business Practice Location Address Fax Number:
570-609-5387
Provider Enumeration Date:
10/04/2005