Provider First Line Business Practice Location Address:
110 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIUM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15834-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-486-3736
Provider Business Practice Location Address Fax Number:
814-486-3827
Provider Enumeration Date:
07/07/2005