Provider First Line Business Practice Location Address:
215 E 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARENTUM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15084-1765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-224-4510
Provider Business Practice Location Address Fax Number:
724-224-4577
Provider Enumeration Date:
11/15/2005