Provider First Line Business Practice Location Address:
5 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW SALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15468-0075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-245-8414
Provider Business Practice Location Address Fax Number:
724-245-6211
Provider Enumeration Date:
09/26/2006