Provider First Line Business Practice Location Address:
4623 STATE ROUTE 136
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-4433
Provider Business Practice Location Address Fax Number:
724-836-2507
Provider Enumeration Date:
10/18/2006