Provider First Line Business Practice Location Address:
550 W COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PLEASANT GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16823-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-359-1244
Provider Business Practice Location Address Fax Number:
814-359-1232
Provider Enumeration Date:
01/18/2008