Provider First Line Business Practice Location Address:
1527 MIFFLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-506-7142
Provider Business Practice Location Address Fax Number:
717-437-9001
Provider Enumeration Date:
09/12/2014