Provider First Line Business Practice Location Address:
ONE NORTHGATE SQUARE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-216-8490
Provider Business Practice Location Address Fax Number:
724-420-5956
Provider Enumeration Date:
05/12/2009