Provider First Line Business Practice Location Address:
62 SCHOOL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGWAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-773-3146
Provider Business Practice Location Address Fax Number:
814-776-4299
Provider Enumeration Date:
05/28/2006