Provider First Line Business Practice Location Address:
133 S RICHARD ST
Provider Second Line Business Practice Location Address:
BOX 92
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-623-2743
Provider Business Practice Location Address Fax Number:
814-623-7948
Provider Enumeration Date:
07/28/2006