Provider First Line Business Practice Location Address:
211 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CARBON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17965-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-516-4297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2014