Provider First Line Business Practice Location Address:
235 HUMPHREY ROAD
Provider Second Line Business Practice Location Address:
TWO PINEVIEW PLACE SUITE 4
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-7880
Provider Business Practice Location Address Fax Number:
724-832-8172
Provider Enumeration Date:
11/30/2005