Provider First Line Business Practice Location Address:
107 W CENTRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAHANOY CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17948-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-773-2690
Provider Business Practice Location Address Fax Number:
570-773-2691
Provider Enumeration Date:
07/15/2006