Provider First Line Business Practice Location Address:
532 MAIN ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-471-3569
Provider Business Practice Location Address Fax Number:
570-471-7052
Provider Enumeration Date:
07/16/2014