Provider First Line Business Practice Location Address:
251 CORRECTIONS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESSON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16699-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-886-4266
Provider Business Practice Location Address Fax Number:
814-886-8573
Provider Enumeration Date:
02/28/2007