Provider First Line Business Practice Location Address:
1177 S 6TH ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-465-0440
Provider Business Practice Location Address Fax Number:
724-465-0444
Provider Enumeration Date:
06/22/2005