Provider First Line Business Practice Location Address:
109 E LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16830-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-4151
Provider Business Practice Location Address Fax Number:
814-375-7179
Provider Enumeration Date:
01/08/2007