Provider First Line Business Practice Location Address:
611-619 FIFTENNTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-1291
Provider Business Practice Location Address Fax Number:
814-643-7184
Provider Enumeration Date:
12/31/2018