Provider First Line Business Practice Location Address:
171 LOVELL AVE
Provider Second Line Business Practice Location Address:
LOVELL PARK PROFESSIIONAL BLDG.
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-4090
Provider Business Practice Location Address Fax Number:
814-472-9310
Provider Enumeration Date:
08/31/2006