Provider First Line Business Practice Location Address: 
210 MEDICAL CENTER DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PHILIPSBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16866-1948
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-342-8001
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/12/2006