Provider First Line Business Practice Location Address:
128 LYONS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLEHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-697-7165
Provider Business Practice Location Address Fax Number:
814-697-7747
Provider Enumeration Date:
02/07/2007