Provider First Line Business Practice Location Address: 
200 12TH ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FRANKLIN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16323-1217
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-437-3071
    Provider Business Practice Location Address Fax Number: 
814-432-2269
    Provider Enumeration Date: 
09/30/2008