Provider First Line Business Practice Location Address:
124 SUMNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDERGRIFT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15690-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-568-2432
Provider Business Practice Location Address Fax Number:
724-567-0053
Provider Enumeration Date:
08/29/2007