Provider First Line Business Practice Location Address:
125 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICEDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-998-5061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2025