Provider First Line Business Practice Location Address:
2120 LIKENS LN STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARRELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16121-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-6810
Provider Business Practice Location Address Fax Number:
724-981-5617
Provider Enumeration Date:
09/11/2012