Provider First Line Business Practice Location Address:
330 EAST JOHN STREET
Provider Second Line Business Practice Location Address:
ADMINISTRATIVE OFFICE
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15522-1495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-623-4225
Provider Business Practice Location Address Fax Number:
814-623-4228
Provider Enumeration Date:
11/01/2006