Provider First Line Business Practice Location Address:
615 HOWARD AVE
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-355-8215
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2005