Provider First Line Business Practice Location Address:
3002 N TWP BLVD
Provider Second Line Business Practice Location Address:
PITTSTON TWP
Provider Business Practice Location Address City Name:
PITTSTON TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-602-1590
Provider Business Practice Location Address Fax Number:
570-602-1592
Provider Enumeration Date:
02/12/2007