Provider First Line Business Practice Location Address:
101 N FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-1090
Provider Business Practice Location Address Fax Number:
814-343-2597
Provider Enumeration Date:
09/05/2006