Provider First Line Business Practice Location Address:
313 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUNXSUTAWNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15767-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-938-2524
Provider Business Practice Location Address Fax Number:
814-938-5593
Provider Enumeration Date:
12/29/2006