Provider First Line Business Practice Location Address:
3205 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY LAKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-376-7111
Provider Business Practice Location Address Fax Number:
724-376-7165
Provider Enumeration Date:
03/29/2012