Provider First Line Business Practice Location Address:
RR 1 BOX 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLEHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16748-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-697-7188
Provider Business Practice Location Address Fax Number:
716-353-4796
Provider Enumeration Date:
01/02/2007