Provider First Line Business Practice Location Address:
761 JOHNSONBURG ROAD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
ST. MARYS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-834-4399
Provider Business Practice Location Address Fax Number:
814-788-8092
Provider Enumeration Date:
09/20/2006