Provider First Line Business Practice Location Address:
3652 PORTAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15946-6544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-736-9600
Provider Business Practice Location Address Fax Number:
814-266-3407
Provider Enumeration Date:
10/18/2006