Provider First Line Business Practice Location Address:
133 ROUTE 44
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLEHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16748-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-904-0027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2009