Provider First Line Business Practice Location Address:
2056 PLANK ROAD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CARROLLTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15722-0243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-344-2005
Provider Business Practice Location Address Fax Number:
814-344-8197
Provider Enumeration Date:
02/29/2008