Provider First Line Business Practice Location Address:
110 S PLEASANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-1634
Provider Business Practice Location Address Fax Number:
814-444-8934
Provider Enumeration Date:
11/29/2020