Provider First Line Business Practice Location Address:
RR 4 BOX 1564
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-9028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-3121
Provider Business Practice Location Address Fax Number:
724-547-5461
Provider Enumeration Date:
08/31/2006