Provider First Line Business Practice Location Address:
510 PELLIS ROAD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-2255
Provider Business Practice Location Address Fax Number:
724-832-9456
Provider Enumeration Date:
11/01/2006