Provider First Line Business Practice Location Address:
1869 ROUTE 30 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGONIER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-238-2167
Provider Business Practice Location Address Fax Number:
724-238-4074
Provider Enumeration Date:
03/19/2007