Provider First Line Business Practice Location Address:
237 SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15479-0479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-872-7202
Provider Business Practice Location Address Fax Number:
724-872-0775
Provider Enumeration Date:
11/14/2006