Provider First Line Business Practice Location Address:
104 S CENTER ST
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-471-9210
Provider Business Practice Location Address Fax Number:
814-471-2988
Provider Enumeration Date:
10/10/2005