Provider First Line Business Practice Location Address:
210 E LOCUST 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:
16866-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-4711
Provider Business Practice Location Address Fax Number:
814-342-1689
Provider Enumeration Date:
01/11/2006