Provider First Line Business Practice Location Address:
428 N SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-342-5367
Provider Business Practice Location Address Fax Number:
814-342-8044
Provider Enumeration Date:
08/22/2006