Provider First Line Business Practice Location Address:
125 HARTMAN RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-6620
Provider Business Practice Location Address Fax Number:
724-836-1268
Provider Enumeration Date:
10/19/2005