Provider First Line Business Practice Location Address:
3910 BIRNEY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-963-1033
Provider Business Practice Location Address Fax Number:
570-558-1709
Provider Enumeration Date:
03/01/2007