Provider First Line Business Practice Location Address:
4639 STATE ROUTE 136
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-838-1020
Provider Business Practice Location Address Fax Number:
724-838-1082
Provider Enumeration Date:
08/01/2006