Provider First Line Business Practice Location Address:
12320 ROUTE 30
Provider Second Line Business Practice Location Address:
SUITES 4 & 6
Provider Business Practice Location Address City Name:
NORTH HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-1872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-863-6488
Provider Business Practice Location Address Fax Number:
724-863-6488
Provider Enumeration Date:
03/09/2006