Provider First Line Business Practice Location Address:
122 E ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLEHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16748-7107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-697-6331
Provider Business Practice Location Address Fax Number:
814-697-7437
Provider Enumeration Date:
07/30/2006