Provider First Line Business Practice Location Address:
105 WEST DUBOIS AVENUE
Provider Second Line Business Practice Location Address:
JUNIATA PLACE SUITE B
Provider Business Practice Location Address City Name:
DUBOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-7090
Provider Business Practice Location Address Fax Number:
814-375-7940
Provider Enumeration Date:
04/02/2008