Provider First Line Business Practice Location Address:
801 HOWARD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-946-2846
Provider Business Practice Location Address Fax Number:
814-946-1273
Provider Enumeration Date:
06/03/2006