Provider First Line Business Practice Location Address:
409 CENTER ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-965-2433
Provider Business Practice Location Address Fax Number:
814-965-2421
Provider Enumeration Date:
09/12/2024