Provider First Line Business Practice Location Address:
61 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-725-4492
Provider Business Practice Location Address Fax Number:
814-725-4427
Provider Enumeration Date:
11/21/2006