Provider First Line Business Practice Location Address:
1101 W PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-1700
Provider Business Practice Location Address Fax Number:
570-648-1490
Provider Enumeration Date:
09/23/2005