Provider First Line Business Practice Location Address:
314 OLD ROUTE 30 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-0389
Provider Business Practice Location Address Fax Number:
724-834-0390
Provider Enumeration Date:
07/21/2009