Provider First Line Business Practice Location Address:
1265 WAYNE AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-7530
Provider Business Practice Location Address Fax Number:
724-349-7531
Provider Enumeration Date:
01/10/2007