Provider First Line Business Practice Location Address:
511 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15066-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-581-4121
Provider Business Practice Location Address Fax Number:
724-581-4429
Provider Enumeration Date:
09/23/2010