Provider First Line Business Practice Location Address:
518 TWENTY MINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15722-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-344-8524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2011