Provider First Line Business Practice Location Address:
284 TERRA COTTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSONBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-310-0926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2005