Provider First Line Business Practice Location Address: 
21 FRANKLIN VILLAGE MALL
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
KITTANNING
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16201-8803
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-543-3278
    Provider Business Practice Location Address Fax Number: 
724-431-4306
    Provider Enumeration Date: 
02/13/2023