Provider First Line Business Practice Location Address:
612 CLARA ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HOUTZDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16651-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-378-7700
Provider Business Practice Location Address Fax Number:
814-378-7704
Provider Enumeration Date:
01/21/2012