Provider First Line Business Practice Location Address:
217 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15438-0067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-326-9945
Provider Business Practice Location Address Fax Number:
724-326-4476
Provider Enumeration Date:
08/15/2005