Provider First Line Business Practice Location Address:
70 1/2 MECHANIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-6129
Provider Business Practice Location Address Fax Number:
814-368-6174
Provider Enumeration Date:
09/28/2006