Provider First Line Business Practice Location Address:
206 WEST PLUM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16412-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-734-1952
Provider Business Practice Location Address Fax Number:
814-734-1955
Provider Enumeration Date:
02/20/2008