Provider First Line Business Practice Location Address:
161 E OTTERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-5199
Provider Business Practice Location Address Fax Number:
724-836-5699
Provider Enumeration Date:
07/24/2006