Provider First Line Business Practice Location Address:
130 W PLANK RD
Provider Second Line Business Practice Location Address:
SEARS LOGAN VALLEY MALL
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16602-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-944-8685
Provider Business Practice Location Address Fax Number:
814-942-4313
Provider Enumeration Date:
11/18/2005