Provider First Line Business Practice Location Address:
1609 PITT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENNERSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-629-6621
Provider Business Practice Location Address Fax Number:
814-629-6622
Provider Enumeration Date:
02/26/2010