Provider First Line Business Practice Location Address:
800 SOUTH LOGAN BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
HOLLIDAYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16648-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-944-2097
Provider Business Practice Location Address Fax Number:
814-941-2303
Provider Enumeration Date:
07/20/2005