Provider First Line Business Practice Location Address:
6583 STATE ROUTE 819 S
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-542-9702
Provider Business Practice Location Address Fax Number:
724-542-9704
Provider Enumeration Date:
12/17/2014