Provider First Line Business Practice Location Address:
50 E LOCUST ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NESQUEHONING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18240-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-669-9818
Provider Business Practice Location Address Fax Number:
570-669-9841
Provider Enumeration Date:
06/14/2007