Provider First Line Business Practice Location Address:
1701 12TH AVE
Provider Second Line Business Practice Location Address:
G1
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-942-1881
Provider Business Practice Location Address Fax Number:
814-942-1802
Provider Enumeration Date:
12/18/2008