Provider First Line Business Practice Location Address:
COLLEGE PARK PLAZA
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-9070
Provider Business Practice Location Address Fax Number:
814-472-9067
Provider Enumeration Date:
11/22/2006