Provider First Line Business Practice Location Address:
545 PROSPECT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANS CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16033-7833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-538-3669
Provider Business Practice Location Address Fax Number:
724-538-8738
Provider Enumeration Date:
12/09/2007