Provider First Line Business Practice Location Address:
816 ELIZABETH STREET BOX 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-378-8622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2006