Provider First Line Business Practice Location Address:
612 CLARA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-378-9716
Provider Business Practice Location Address Fax Number:
814-378-8940
Provider Enumeration Date:
08/31/2006