Provider First Line Business Practice Location Address:
196 OLD ROUTE 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-838-7632
Provider Business Practice Location Address Fax Number:
724-836-3655
Provider Enumeration Date:
09/01/2006