Provider First Line Business Practice Location Address:
369 PHOENIX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEFONTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-355-2907
Provider Business Practice Location Address Fax Number:
814-355-8702
Provider Enumeration Date:
06/01/2005