Provider First Line Business Practice Location Address:
601 CONEWANGO AVE
Provider Second Line Business Practice Location Address:
WARREN STATE HOSPITAL 33 MAIN DR.
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-726-4531
Provider Business Practice Location Address Fax Number:
718-726-4499
Provider Enumeration Date:
02/27/2007