Provider First Line Business Practice Location Address:
164 MEDICAL CENTER RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CHICORA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16025-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-445-3027
Provider Business Practice Location Address Fax Number:
724-445-7227
Provider Enumeration Date:
10/23/2006