Provider First Line Business Practice Location Address:
330 ENTERPRISE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-3174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-6636
Provider Business Practice Location Address Fax Number:
814-342-5230
Provider Enumeration Date:
07/13/2006