Provider First Line Business Practice Location Address:
173 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUZERNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18709-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-2262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2006