Provider First Line Business Practice Location Address:
24 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-1280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-368-4630
Provider Business Practice Location Address Fax Number:
814-368-1007
Provider Enumeration Date:
06/29/2006