Provider First Line Business Practice Location Address:
110 POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-228-4212
Provider Business Practice Location Address Fax Number:
724-229-9252
Provider Enumeration Date:
07/02/2007