Provider First Line Business Practice Location Address:
2060 N PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-877-7711
Provider Business Practice Location Address Fax Number:
814-877-7715
Provider Enumeration Date:
06/17/2014