Provider First Line Business Practice Location Address:
101 WEST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOALSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-466-7470
Provider Business Practice Location Address Fax Number:
814-466-7407
Provider Enumeration Date:
12/27/2007