Provider First Line Business Practice Location Address:
12430 LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EAST
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16428-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-725-4850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2006