Provider First Line Business Practice Location Address:
401 NORTH 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-9170
Provider Business Practice Location Address Fax Number:
724-349-9182
Provider Enumeration Date:
08/18/2006