Provider First Line Business Practice Location Address:
650 S 13TH ST
Provider Second Line Business Practice Location Address:
UNIT 123, #24
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-6505
Provider Business Practice Location Address Fax Number:
724-349-6560
Provider Enumeration Date:
03/23/2007