Provider First Line Business Practice Location Address:
1205 PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15066-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-843-2883
Provider Business Practice Location Address Fax Number:
724-843-3648
Provider Enumeration Date:
07/26/2006