Provider First Line Business Practice Location Address:
518 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMLENTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16373-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-867-1212
Provider Business Practice Location Address Fax Number:
724-867-8022
Provider Enumeration Date:
10/19/2009