Provider First Line Business Practice Location Address:
402 S HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT MATILDA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16870-0495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-692-1035
Provider Business Practice Location Address Fax Number:
814-692-1030
Provider Enumeration Date:
12/09/2011