Provider First Line Business Practice Location Address:
33 GATEWAY SHOPPING CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-287-1955
Provider Business Practice Location Address Fax Number:
570-287-1995
Provider Enumeration Date:
11/04/2010