Provider First Line Business Practice Location Address:
9333 STATE ROUTE 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17866-4170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-6198
Provider Business Practice Location Address Fax Number:
570-500-1190
Provider Enumeration Date:
02/27/2006