Provider First Line Business Practice Location Address:
131 S PLEASANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-9500
Provider Business Practice Location Address Fax Number:
814-445-5410
Provider Enumeration Date:
09/30/2006