Provider First Line Business Practice Location Address:
508 S CHURCH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-7212
Provider Business Practice Location Address Fax Number:
724-547-7278
Provider Enumeration Date:
10/12/2005