Provider First Line Business Practice Location Address:
29 IRVIN DRIVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-5361
Provider Business Practice Location Address Fax Number:
814-342-2360
Provider Enumeration Date:
08/31/2006