Provider First Line Business Practice Location Address:
223 S PLEASANT AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-1028
Provider Business Practice Location Address Fax Number:
814-443-2910
Provider Enumeration Date:
04/22/2009