Provider First Line Business Practice Location Address:
200 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16686-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-4676
Provider Business Practice Location Address Fax Number:
814-684-3692
Provider Enumeration Date:
05/19/2006