Provider First Line Business Practice Location Address:
120 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ALLEGANY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16743-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-642-9541
Provider Business Practice Location Address Fax Number:
814-642-9596
Provider Enumeration Date:
12/12/2006