Provider First Line Business Practice Location Address:
50 MERRICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-8988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-276-1578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2005