Provider First Line Business Practice Location Address:
1049 SHOEMAKER ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANTY GLO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15943-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-736-3044
Provider Business Practice Location Address Fax Number:
814-736-9522
Provider Enumeration Date:
09/30/2009