Provider First Line Business Practice Location Address:
HC 1 BOX 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16217-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-752-2979
Provider Business Practice Location Address Fax Number:
814-752-6456
Provider Enumeration Date:
11/10/2006