Provider First Line Business Practice Location Address:
1452 E LACKAWANNA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYPHANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-291-8397
Provider Business Practice Location Address Fax Number:
570-754-9768
Provider Enumeration Date:
02/22/2020