Provider First Line Business Practice Location Address:
RR 6
Provider Second Line Business Practice Location Address:
WALTON TEA ROOM ROAD
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-9806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-527-5959
Provider Business Practice Location Address Fax Number:
724-523-5135
Provider Enumeration Date:
05/03/2006