Provider First Line Business Practice Location Address:
16 LUZERNE AVE
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
WEST PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18643-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-6714
Provider Business Practice Location Address Fax Number:
570-654-9599
Provider Enumeration Date:
11/15/2005