Provider First Line Business Practice Location Address:
419 WATERFORD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16412-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-734-5021
Provider Business Practice Location Address Fax Number:
814-734-1433
Provider Enumeration Date:
11/30/2015