Provider First Line Business Practice Location Address:
210 E PLANK RD
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-429-6222
Provider Business Practice Location Address Fax Number:
814-296-2225
Provider Enumeration Date:
10/17/2006