Provider First Line Business Practice Location Address:
251 SEVENTH ST
Provider Second Line Business Practice Location Address:
SUITE 201B
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-6534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-335-6662
Provider Business Practice Location Address Fax Number:
724-335-3010
Provider Enumeration Date:
01/16/2015