Provider First Line Business Practice Location Address:
165 RED DOG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15043-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-252-5724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2025