Provider First Line Business Practice Location Address:
1265 WAYNE AVE
Provider Second Line Business Practice Location Address:
119 PROF. BLDG, SUITE 103
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-463-1046
Provider Business Practice Location Address Fax Number:
724-463-2314
Provider Enumeration Date:
09/20/2006