Provider First Line Business Practice Location Address:
138 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-4780
Provider Business Practice Location Address Fax Number:
814-443-4758
Provider Enumeration Date:
07/22/2005