Provider First Line Business Practice Location Address:
235 HUMPHREY ROAD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-838-8818
Provider Business Practice Location Address Fax Number:
724-838-1791
Provider Enumeration Date:
11/21/2006