Provider First Line Business Practice Location Address:
730 N JULIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-471-6999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2005