Provider First Line Business Practice Location Address:
116 INTERSTATE PKWY STE 32
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-1020
Provider Business Practice Location Address Fax Number:
814-368-1024
Provider Enumeration Date:
07/07/2005