Provider First Line Business Practice Location Address:
143 W. MAIN ST.
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-347-5018
Provider Business Practice Location Address Fax Number:
814-347-5186
Provider Enumeration Date:
08/07/2017