Provider First Line Business Practice Location Address:
467 E PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-808-6742
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2025