Provider First Line Business Practice Location Address:
199 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 32
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-362-8717
Provider Business Practice Location Address Fax Number:
814-368-2085
Provider Enumeration Date:
11/10/2006