Provider First Line Business Practice Location Address:
651 S CENTER AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-0789
Provider Business Practice Location Address Fax Number:
814-443-4924
Provider Enumeration Date:
10/13/2006