Provider First Line Business Practice Location Address:
1174 WYOMING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTY FORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-9444
Provider Business Practice Location Address Fax Number:
570-331-7543
Provider Enumeration Date:
02/11/2008