Provider First Line Business Practice Location Address:
3242 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
BOX 487
Provider Business Practice Location Address City Name:
SANDY LAKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-376-7161
Provider Business Practice Location Address Fax Number:
724-376-3754
Provider Enumeration Date:
08/18/2005