Provider First Line Business Practice Location Address:
1013 LEDGEVIEW DR
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:
18643-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-655-0238
Provider Business Practice Location Address Fax Number:
570-288-5900
Provider Enumeration Date:
05/17/2006