Provider First Line Business Practice Location Address:
501 HOWARD AVE
Provider Second Line Business Practice Location Address:
SUITE B205
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-889-2677
Provider Business Practice Location Address Fax Number:
814-889-7966
Provider Enumeration Date:
05/16/2006