Provider First Line Business Practice Location Address:
1500 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-2200
Provider Business Practice Location Address Fax Number:
724-836-2200
Provider Enumeration Date:
05/28/2007