Provider First Line Business Practice Location Address:
1464 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
PUNXSUTAWNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15767-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-938-2300
Provider Business Practice Location Address Fax Number:
814-938-6878
Provider Enumeration Date:
02/22/2006