Provider First Line Business Practice Location Address:
31 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KINGSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17072-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-946-8189
Provider Business Practice Location Address Fax Number:
814-943-4885
Provider Enumeration Date:
10/26/2006