Provider First Line Business Practice Location Address:
615 HOWARD AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-312-3459
Provider Business Practice Location Address Fax Number:
814-942-9725
Provider Enumeration Date:
01/13/2009