Provider First Line Business Practice Location Address:
31 N MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-7770
Provider Business Practice Location Address Fax Number:
724-838-7731
Provider Enumeration Date:
11/07/2005