Provider First Line Business Practice Location Address:
54 - 56 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ALLEGANY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16743-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-642-2871
Provider Business Practice Location Address Fax Number:
814-642-7724
Provider Enumeration Date:
02/12/2007