Provider First Line Business Practice Location Address:
580 OLD ROUTE 322
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:
814-342-5678
Provider Business Practice Location Address Fax Number:
814-342-0532
Provider Enumeration Date:
03/20/2015