Provider First Line Business Practice Location Address:
111-113 COBB ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-965-5279
Provider Business Practice Location Address Fax Number:
814-965-4251
Provider Enumeration Date:
09/01/2015