Provider First Line Business Practice Location Address:
322-2 E PINE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-937-0668
Provider Business Practice Location Address Fax Number:
814-342-2532
Provider Enumeration Date:
11/24/2015