Provider First Line Business Practice Location Address:
2000 NORTHWESTERN DR
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:
17866-4167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-644-5350
Provider Business Practice Location Address Fax Number:
570-644-5396
Provider Enumeration Date:
05/11/2007