Provider First Line Business Practice Location Address:
4113 BIRNEY AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MOOSIC
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18507-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-7883
Provider Business Practice Location Address Fax Number:
570-343-7886
Provider Enumeration Date:
04/06/2007