Provider First Line Business Practice Location Address:
103 W MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-8304
Provider Business Practice Location Address Fax Number:
843-342-8305
Provider Enumeration Date:
06/09/2006