Provider First Line Business Practice Location Address:
48 W PHILLIPS 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:
18218-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-645-2184
Provider Business Practice Location Address Fax Number:
570-645-3297
Provider Enumeration Date:
07/04/2006