Provider First Line Business Practice Location Address:
151 JOHN BRADY DR
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
PENNSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-8425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-546-8255
Provider Business Practice Location Address Fax Number:
570-546-3668
Provider Enumeration Date:
06/27/2005