Provider First Line Business Practice Location Address:
1 KISKI AVENUE EXT
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LEECHBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15656-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-845-6755
Provider Business Practice Location Address Fax Number:
724-845-2533
Provider Enumeration Date:
05/22/2008