Provider First Line Business Practice Location Address:
947 BELLEFONTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-7751
Provider Business Practice Location Address Fax Number:
570-748-3967
Provider Enumeration Date:
07/31/2006