Provider First Line Business Practice Location Address:
201 SOUTH FAIRFIELD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGONIER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-238-3066
Provider Business Practice Location Address Fax Number:
724-238-2047
Provider Enumeration Date:
10/19/2006