Provider First Line Business Practice Location Address:
425 FRYE FARM RD
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:
15601-6480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-532-0866
Provider Business Practice Location Address Fax Number:
724-532-0869
Provider Enumeration Date:
06/23/2006