Provider First Line Business Practice Location Address:
621 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LIGONIER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15658-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-238-4103
Provider Business Practice Location Address Fax Number:
724-238-4107
Provider Enumeration Date:
12/30/2005