Provider First Line Business Practice Location Address:
1998 BAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSTON TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-9511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-237-0939
Provider Business Practice Location Address Fax Number:
570-824-6621
Provider Enumeration Date:
08/03/2006