Provider First Line Business Practice Location Address:
313 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-371-5565
Provider Business Practice Location Address Fax Number:
814-371-5678
Provider Enumeration Date:
04/24/2006