Provider First Line Business Practice Location Address:
130 W NORTH ST STE P
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16101-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-218-0830
Provider Business Practice Location Address Fax Number:
253-217-4306
Provider Enumeration Date:
04/12/2023