Provider First Line Business Practice Location Address: 
501 VALLEY VIEW BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ALTOONA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16602-6410
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-944-5014
    Provider Business Practice Location Address Fax Number: 
814-944-6500
    Provider Enumeration Date: 
10/04/2006