Provider First Line Business Practice Location Address:
1099 SOUTH TOWNSHIP BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-1287
Provider Business Practice Location Address Fax Number:
570-654-4377
Provider Enumeration Date:
04/06/2006