Provider First Line Business Practice Location Address:
135 EAST MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15717-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-459-5310
Provider Business Practice Location Address Fax Number:
724-459-5848
Provider Enumeration Date:
05/03/2007