Provider First Line Business Practice Location Address:
119 CALEB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-378-5354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2008