Provider First Line Business Practice Location Address:
120 W ALLEGHENY RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15126-9788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-695-7274
Provider Business Practice Location Address Fax Number:
724-695-7815
Provider Enumeration Date:
07/06/2005