Provider First Line Business Practice Location Address:
302 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15697-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-755-2124
Provider Business Practice Location Address Fax Number:
724-755-0829
Provider Enumeration Date:
06/01/2005