Provider First Line Business Practice Location Address:
620 HOWARD AVENUE
Provider Second Line Business Practice Location Address:
DIETITIAN'S OFFICE, 4TH FLOOR
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-889-3976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2021