Provider First Line Business Practice Location Address:
217 LACKAWANNA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18641-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-2901
Provider Business Practice Location Address Fax Number:
570-654-1568
Provider Enumeration Date:
10/05/2005