Provider First Line Business Practice Location Address:
953 E CATAWISSA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NESQUEHONING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18240-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-669-6684
Provider Business Practice Location Address Fax Number:
570-669-6718
Provider Enumeration Date:
09/23/2005