Provider First Line Business Practice Location Address:
145 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-3913
Provider Business Practice Location Address Fax Number:
814-375-5258
Provider Enumeration Date:
08/01/2006