Provider First Line Business Practice Location Address:
114 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16371-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-563-3400
Provider Business Practice Location Address Fax Number:
814-563-3407
Provider Enumeration Date:
09/20/2005