Provider First Line Business Practice Location Address:
POLK CENTER
Provider Second Line Business Practice Location Address:
100 LAKEWOOD CIRCLE
Provider Business Practice Location Address City Name:
POLK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16342-0094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-432-0471
Provider Business Practice Location Address Fax Number:
814-432-0179
Provider Enumeration Date:
12/28/2005