Provider First Line Business Practice Location Address:
850 MAIN STREET PO BOX 375
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COALPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16627-0375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-672-5141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2006