Provider First Line Business Practice Location Address:
372 LAKEWOOD 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:
15601-9769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-219-4489
Provider Business Practice Location Address Fax Number:
724-832-1385
Provider Enumeration Date:
06/22/2005