Provider First Line Business Practice Location Address:
400 ROUTE 315 HWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-299-7502
Provider Business Practice Location Address Fax Number:
570-569-2250
Provider Enumeration Date:
11/16/2019