Provider First Line Business Practice Location Address:
4934 GREEN ACRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651-9424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-378-7616
Provider Business Practice Location Address Fax Number:
814-378-7100
Provider Enumeration Date:
07/10/2006