Provider First Line Business Practice Location Address:
1710 MAPLE AVE
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:
17866-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-7860
Provider Business Practice Location Address Fax Number:
570-644-5180
Provider Enumeration Date:
04/27/2010