Provider First Line Business Practice Location Address:
661 BYRNEDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEEDVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15868-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-787-7365
Provider Business Practice Location Address Fax Number:
888-398-6221
Provider Enumeration Date:
07/23/2010