Provider First Line Business Practice Location Address:
982 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHERN CAMBRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15714-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-502-2315
Provider Business Practice Location Address Fax Number:
814-502-2315
Provider Enumeration Date:
03/30/2026