Provider First Line Business Practice Location Address:
221 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16686-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-2501
Provider Business Practice Location Address Fax Number:
814-684-2751
Provider Enumeration Date:
08/06/2009