Provider First Line Business Practice Location Address:
18 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. JEWETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-778-2298
Provider Business Practice Location Address Fax Number:
814-778-7344
Provider Enumeration Date:
11/14/2008