Provider First Line Business Practice Location Address:
2120 FREEPORT RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-594-1090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2009