Provider First Line Business Practice Location Address:
550 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT MICHAEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15951-0306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-495-7127
Provider Business Practice Location Address Fax Number:
814-495-4008
Provider Enumeration Date:
07/14/2005