Provider First Line Business Practice Location Address:
116 INTERSTATE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-4143
Provider Business Practice Location Address Fax Number:
814-362-8078
Provider Enumeration Date:
07/21/2005