Provider First Line Business Practice Location Address:
4 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15697-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-635-0767
Provider Business Practice Location Address Fax Number:
724-635-0770
Provider Enumeration Date:
10/22/2012