Provider First Line Business Practice Location Address:
790 BRYAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16652-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-643-8299
Provider Business Practice Location Address Fax Number:
814-643-8300
Provider Enumeration Date:
12/20/2005