Provider First Line Business Practice Location Address:
208 BUTLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTONVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-385-1137
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2005