Provider First Line Business Practice Location Address:
12650 EDINBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16412-6016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-734-4541
Provider Business Practice Location Address Fax Number:
814-734-5562
Provider Enumeration Date:
11/15/2011