Provider First Line Business Practice Location Address:
549 LOCUST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDMAN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15955-0158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-487-7613
Provider Business Practice Location Address Fax Number:
814-487-7775
Provider Enumeration Date:
08/29/2006