Provider First Line Business Practice Location Address:
1036 PARK AVENUE EXTENSION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-9677
Provider Business Practice Location Address Fax Number:
814-765-9514
Provider Enumeration Date:
04/13/2006