Provider First Line Business Practice Location Address:
9143 ROUTE 119 HIGHWAY SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15717-6731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-471-3037
Provider Business Practice Location Address Fax Number:
724-471-7105
Provider Enumeration Date:
01/21/2011