Provider First Line Business Practice Location Address:
401 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALEXANDRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-668-7833
Provider Business Practice Location Address Fax Number:
724-668-8346
Provider Enumeration Date:
12/30/2005