Provider First Line Business Practice Location Address:
1122 WEST PORTERSVILLE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16051-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-368-8813
Provider Business Practice Location Address Fax Number:
724-794-1633
Provider Enumeration Date:
10/12/2006