Provider First Line Business Practice Location Address:
400 E 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:
16371-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-563-7591
Provider Business Practice Location Address Fax Number:
814-563-9760
Provider Enumeration Date:
11/04/2016