Provider First Line Business Practice Location Address:
850 LEONARD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-205-4004
Provider Business Practice Location Address Fax Number:
814-205-4013
Provider Enumeration Date:
10/30/2012