Provider First Line Business Practice Location Address:
564 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST WYOMING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18644-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-814-8447
Provider Business Practice Location Address Fax Number:
570-214-0381
Provider Enumeration Date:
03/25/2026