Provider First Line Business Practice Location Address:
101 HAKES ST
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:
17866-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-0424
Provider Business Practice Location Address Fax Number:
570-648-3560
Provider Enumeration Date:
02/06/2006