Provider First Line Business Practice Location Address:
660 RED DOG ROAD EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15043-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-462-8696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2012