Provider First Line Business Practice Location Address:
626 WATER STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ORBISONIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-447-5556
Provider Business Practice Location Address Fax Number:
814-447-5682
Provider Enumeration Date:
03/17/2006