Provider First Line Business Practice Location Address:
1792 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16635-8378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-317-5188
Provider Business Practice Location Address Fax Number:
814-317-5283
Provider Enumeration Date:
07/22/2005