Provider First Line Business Practice Location Address:
95 LEONARD AVE
Provider Second Line Business Practice Location Address:
SUITE 104 BLDG. 1
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-206-9149
Provider Business Practice Location Address Fax Number:
724-206-9156
Provider Enumeration Date:
08/31/2006