Provider First Line Business Practice Location Address:
902 W MAIN ST
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:
15666-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-423-6217
Provider Business Practice Location Address Fax Number:
724-423-1827
Provider Enumeration Date:
12/29/2006