Provider First Line Business Practice Location Address:
144 HUGH BLACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-613-2449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2011