Provider First Line Business Practice Location Address:
125 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 201 HOOKER FULTON BLDG
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-7144
Provider Business Practice Location Address Fax Number:
814-368-7145
Provider Enumeration Date:
03/09/2006