Provider First Line Business Practice Location Address:
5256 STATE ROUTH 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:
724-837-1999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006