Provider First Line Business Practice Location Address:
RR 4 BOX 646
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:
18643-9321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-388-4094
Provider Business Practice Location Address Fax Number:
570-388-2104
Provider Enumeration Date:
08/29/2008