Provider First Line Business Practice Location Address:
564 THEATRE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15722-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-344-8480
Provider Business Practice Location Address Fax Number:
814-344-2205
Provider Enumeration Date:
08/13/2012