Provider First Line Business Practice Location Address:
5126 ROUTE 30
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-3027
Provider Business Practice Location Address Fax Number:
724-836-3029
Provider Enumeration Date:
03/16/2010