Provider First Line Business Practice Location Address:
1003 N GREENGATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-8061
Provider Business Practice Location Address Fax Number:
724-832-9311
Provider Enumeration Date:
05/23/2006