Provider First Line Business Practice Location Address:
638 FOURTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-339-2229
Provider Business Practice Location Address Fax Number:
724-339-7733
Provider Enumeration Date:
05/11/2006