Provider First Line Business Practice Location Address:
1301 MOUNT VERNON AVE
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:
16652-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-5724
Provider Business Practice Location Address Fax Number:
814-643-6085
Provider Enumeration Date:
11/04/2010