Provider First Line Business Practice Location Address:
951 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
925 S. LINCOLN AVENUE
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16686-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-0320
Provider Business Practice Location Address Fax Number:
814-684-0902
Provider Enumeration Date:
10/18/2005