Provider First Line Business Practice Location Address:
211 1/2 EAST LOCUST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-577-5634
Provider Business Practice Location Address Fax Number:
814-371-0120
Provider Enumeration Date:
12/30/2010