Provider First Line Business Practice Location Address:
145 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15537-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-652-9348
Provider Business Practice Location Address Fax Number:
814-652-0189
Provider Enumeration Date:
09/29/2006