Provider First Line Business Practice Location Address:
142 W ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCHRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16314-8640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-638-0238
Provider Business Practice Location Address Fax Number:
814-638-0007
Provider Enumeration Date:
05/17/2013