Provider First Line Business Practice Location Address:
211 1/2 E LOCUST ST
Provider Second Line Business Practice Location Address:
SUITE #7
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-765-0302
Provider Business Practice Location Address Fax Number:
814-765-0262
Provider Enumeration Date:
12/29/2009