Provider First Line Business Practice Location Address:
59 W MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16125-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-588-4805
Provider Business Practice Location Address Fax Number:
724-588-4809
Provider Enumeration Date:
11/02/2005