Provider First Line Business Practice Location Address:
233 N FRONT ST APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-4611
Provider Business Practice Location Address Fax Number:
814-237-1851
Provider Enumeration Date:
03/10/2026