Provider First Line Business Practice Location Address:
RR 7 BOX 812
Provider Second Line Business Practice Location Address:
CROSSROADS PLAZA
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-1800
Provider Business Practice Location Address Fax Number:
724-547-1802
Provider Enumeration Date:
01/19/2007