Provider First Line Business Practice Location Address:
81 CLARION RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-965-5810
Provider Business Practice Location Address Fax Number:
814-965-2200
Provider Enumeration Date:
11/28/2007