Provider First Line Business Practice Location Address:
709 ROUSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16371-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-563-6412
Provider Business Practice Location Address Fax Number:
814-563-9049
Provider Enumeration Date:
07/24/2009