Provider First Line Business Practice Location Address:
RR 4 BOX 2222
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-9041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-4100
Provider Business Practice Location Address Fax Number:
724-547-0526
Provider Enumeration Date:
06/25/2006