Provider First Line Business Practice Location Address:
714 PHILADELPHIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-994-4066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2011