Provider First Line Business Practice Location Address:
1624 W STATE ST
Provider Second Line Business Practice Location Address:
NORTHERN LIGHTS SHOPPING PLAZA
Provider Business Practice Location Address City Name:
BADEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15005-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-869-0446
Provider Business Practice Location Address Fax Number:
724-869-1270
Provider Enumeration Date:
07/27/2006