Provider First Line Business Practice Location Address:
3135 NEW GERMANY RD
Provider Second Line Business Practice Location Address:
SUITE 33
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-419-8445
Provider Business Practice Location Address Fax Number:
814-419-8439
Provider Enumeration Date:
12/09/2005