Provider First Line Business Practice Location Address:
231 S MAIN ST
Provider Second Line Business Practice Location Address:
RM 307 COUTLER BUILDING
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-9470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006