Provider First Line Business Practice Location Address:
88 1/2 JUNIPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMER CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15748-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-479-3992
Provider Business Practice Location Address Fax Number:
724-479-2469
Provider Enumeration Date:
02/27/2006