Provider First Line Business Practice Location Address:
130 S MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLEHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16748-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-697-6129
Provider Business Practice Location Address Fax Number:
814-697-7747
Provider Enumeration Date:
02/15/2006