Provider First Line Business Practice Location Address:
220 N BUHL FARM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-342-2789
Provider Business Practice Location Address Fax Number:
724-342-3119
Provider Enumeration Date:
11/29/2005