Provider First Line Business Practice Location Address:
233 N FRONT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-4611
Provider Business Practice Location Address Fax Number:
814-342-5840
Provider Enumeration Date:
10/05/2006