Provider First Line Business Practice Location Address:
565 NATIONAL PIKE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15417-9221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-785-7633
Provider Business Practice Location Address Fax Number:
724-785-7632
Provider Enumeration Date:
09/12/2006