Provider First Line Business Practice Location Address:
10 PARK ST
Provider Second Line Business Practice Location Address:
WARREN STATE HOSP. 33 MAIN DRIVE
Provider Business Practice Location Address City Name:
NORTH WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-5266
Provider Business Practice Location Address Fax Number:
814-726-4499
Provider Enumeration Date:
11/08/2006