Provider First Line Business Practice Location Address:
741 N CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-9147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-8199
Provider Business Practice Location Address Fax Number:
724-547-9824
Provider Enumeration Date:
11/17/2005