Provider First Line Business Practice Location Address:
75 GLENMAURA NATIONAL BLVD
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:
18507-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-4141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2026