Provider First Line Business Practice Location Address:
136 MEADOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15926-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-754-4006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2009