Provider First Line Business Practice Location Address:
126 E CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-1281
Provider Business Practice Location Address Fax Number:
814-443-3214
Provider Enumeration Date:
04/10/2006