Provider First Line Business Practice Location Address:
3520 ROUTE 130
Provider Second Line Business Practice Location Address:
LEVERINGTON COMPLEX - PENN TOWNSHIP
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-744-0950
Provider Business Practice Location Address Fax Number:
724-744-1008
Provider Enumeration Date:
03/10/2006