Provider First Line Business Practice Location Address:
7686 W RIDGE RD
Provider Second Line Business Practice Location Address:
BOX 65
Provider Business Practice Location Address City Name:
FAIRVIEW
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16415-1074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-474-1527
Provider Business Practice Location Address Fax Number:
814-474-5022
Provider Enumeration Date:
10/18/2005