Provider First Line Business Practice Location Address:
601 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-875-8058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2015