Provider First Line Business Practice Location Address:
401 TUNKHANNOCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18643-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-2747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006