Provider First Line Business Practice Location Address:
1045 ROUTE 519
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
EIGHTY FOUR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15330-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-2512
Provider Business Practice Location Address Fax Number:
724-222-2527
Provider Enumeration Date:
06/10/2005