Provider First Line Business Practice Location Address:
212 HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-796-9161
Provider Business Practice Location Address Fax Number:
814-796-1211
Provider Enumeration Date:
09/26/2007