Provider First Line Business Practice Location Address:
127 COLUMBIA 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:
15690-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-567-7520
Provider Business Practice Location Address Fax Number:
724-568-2169
Provider Enumeration Date:
11/29/2005