Provider First Line Business Practice Location Address:
436 JACOBS HILL RD
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:
16748-5118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-307-6253
Provider Business Practice Location Address Fax Number:
814-697-7626
Provider Enumeration Date:
05/14/2012