Provider First Line Business Practice Location Address:
2050 TREVORTORN ROAD
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:
17866-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-4400
Provider Business Practice Location Address Fax Number:
570-644-4403
Provider Enumeration Date:
11/17/2009