Provider First Line Business Practice Location Address:
3379 PITTSBURGH RD
Provider Second Line Business Practice Location Address:
BOX 621
Provider Business Practice Location Address City Name:
PERRYOPOLIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15473-0621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-736-2481
Provider Business Practice Location Address Fax Number:
724-736-2483
Provider Enumeration Date:
01/29/2007