Provider First Line Business Practice Location Address:
1171 GARDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-1233
Provider Business Practice Location Address Fax Number:
724-832-2489
Provider Enumeration Date:
07/09/2006