Provider First Line Business Practice Location Address:
326 FRYE FARM RD
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:
15601-6479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-205-6185
Provider Business Practice Location Address Fax Number:
724-691-0315
Provider Enumeration Date:
09/27/2005