Provider First Line Business Practice Location Address:
PO BOX 604
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:
16748-0604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-558-2743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2024