Provider First Line Business Practice Location Address:
2000 W STATE 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:
17866-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-5752
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2024