Provider First Line Business Practice Location Address:
1104 W HIGH ST
Provider Second Line Business Practice Location Address:
UNIT 4A
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-9355
Provider Business Practice Location Address Fax Number:
814-472-0886
Provider Enumeration Date:
10/11/2006