Provider First Line Business Practice Location Address:
240 W MAHONING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUNXSUTAWNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15767-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-938-1830
Provider Business Practice Location Address Fax Number:
814-939-1982
Provider Enumeration Date:
08/18/2006