Provider First Line Business Practice Location Address:
209 INSTITUTIONAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16698-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-3980
Provider Business Practice Location Address Fax Number:
814-371-8317
Provider Enumeration Date:
09/14/2010