Provider First Line Business Practice Location Address:
350 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-655-6626
Provider Business Practice Location Address Fax Number:
570-654-6974
Provider Enumeration Date:
12/11/2006