Provider First Line Business Practice Location Address:
106 WATERFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16412-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-734-3422
Provider Business Practice Location Address Fax Number:
814-734-1115
Provider Enumeration Date:
08/15/2006