Provider First Line Business Practice Location Address:
145 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-8055
Provider Business Practice Location Address Fax Number:
814-375-8056
Provider Enumeration Date:
06/10/2005