Provider First Line Business Practice Location Address:
9984 MARTIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16423-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-774-3495
Provider Business Practice Location Address Fax Number:
814-774-3497
Provider Enumeration Date:
08/28/2008