Provider First Line Business Practice Location Address:
174 13TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW FLORENCE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15944-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-628-8610
Provider Business Practice Location Address Fax Number:
724-628-2533
Provider Enumeration Date:
01/10/2007