Provider First Line Business Practice Location Address:
908 WYOMING AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18644-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-288-3677
Provider Business Practice Location Address Fax Number:
570-489-4583
Provider Enumeration Date:
09/26/2007