Provider First Line Business Practice Location Address: 
42 S MAIN ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ALBION
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16401-1123
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-756-0899
    Provider Business Practice Location Address Fax Number: 
814-756-8011
    Provider Enumeration Date: 
01/12/2018