Provider First Line Business Practice Location Address:
400 ROUTE 315 HWY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PITTSTON TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-451-3050
Provider Business Practice Location Address Fax Number:
570-451-3055
Provider Enumeration Date:
09/27/2011