Provider First Line Business Practice Location Address:
24 KENNEDY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16701-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-362-3887
Provider Business Practice Location Address Fax Number:
814-368-3335
Provider Enumeration Date:
12/12/2005