Provider First Line Business Practice Location Address:
424 LOCUST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-503-4679
Provider Business Practice Location Address Fax Number:
724-703-1698
Provider Enumeration Date:
03/18/2007