Provider First Line Business Practice Location Address:
17 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARENDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-723-4951
Provider Business Practice Location Address Fax Number:
814-723-5787
Provider Enumeration Date:
10/26/2005