Provider First Line Business Practice Location Address:
1041 3 AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-695-0920
Provider Business Practice Location Address Fax Number:
814-695-0926
Provider Enumeration Date:
03/30/2007