Provider First Line Business Practice Location Address:
1 INTERMEDIATE UNIT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL CENTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15423-9642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-938-3241
Provider Business Practice Location Address Fax Number:
724-938-8722
Provider Enumeration Date:
05/04/2006