Provider First Line Business Practice Location Address:
5840 ROUTE 981
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-5397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-532-1118
Provider Business Practice Location Address Fax Number:
724-532-1307
Provider Enumeration Date:
03/28/2006