Provider First Line Business Practice Location Address:
203 N FRONT ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-312-0647
Provider Business Practice Location Address Fax Number:
814-342-5347
Provider Enumeration Date:
08/12/2010