Provider First Line Business Practice Location Address:
634 FOURTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-339-8600
Provider Business Practice Location Address Fax Number:
724-339-0520
Provider Enumeration Date:
11/21/2007