Provider First Line Business Practice Location Address:
195 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-363-9540
Provider Business Practice Location Address Fax Number:
814-363-9562
Provider Enumeration Date:
06/11/2008