Provider First Line Business Practice Location Address:
20215 ROUTE 19
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-772-9090
Provider Business Practice Location Address Fax Number:
724-772-9160
Provider Enumeration Date:
11/02/2005