Provider First Line Business Practice Location Address:
320 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-3138
Provider Business Practice Location Address Fax Number:
814-765-3410
Provider Enumeration Date:
01/19/2006