Provider First Line Business Practice Location Address:
1177 SOUTH 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-6540
Provider Business Practice Location Address Fax Number:
724-349-8207
Provider Enumeration Date:
07/21/2006