Provider First Line Business Practice Location Address:
145 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-6172
Provider Business Practice Location Address Fax Number:
814-371-3921
Provider Enumeration Date:
10/15/2009