Provider First Line Business Practice Location Address:
108 COAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CARBON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17965-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-7785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2015