Provider First Line Business Practice Location Address:
360 W RUDDLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COALDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18218-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-645-2131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2010