Provider First Line Business Practice Location Address:
12875 ROUTE 30 STE 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-2595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-305-8299
Provider Business Practice Location Address Fax Number:
724-515-7379
Provider Enumeration Date:
08/03/2026