Provider First Line Business Practice Location Address:
804 1/2 LUZERNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18643-1637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
272-892-0466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2024