Provider First Line Business Practice Location Address:
4101 BIRNEY AVE
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:
18507-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-961-3361
Provider Business Practice Location Address Fax Number:
570-961-3364
Provider Enumeration Date:
09/17/2013