Provider First Line Business Practice Location Address:
138 W 25TH ST
Provider Second Line Business Practice Location Address:
SR. LOUIS HOUSE
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16502-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-454-6190
Provider Business Practice Location Address Fax Number:
814-454-5409
Provider Enumeration Date:
04/03/2007