Provider First Line Business Practice Location Address:
365 BENNETT 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:
18709-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-287-6609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2017