Provider First Line Business Practice Location Address:
621 SOUTH FIFTH STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
YOUNGWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-925-6260
Provider Business Practice Location Address Fax Number:
724-925-6260
Provider Enumeration Date:
08/08/2006