Provider First Line Business Practice Location Address:
315 HIGH SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-965-2536
Provider Business Practice Location Address Fax Number:
814-965-5809
Provider Enumeration Date:
05/25/2010