Provider First Line Business Practice Location Address:
929 LYCOMING MALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-7837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-433-8887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2014