Provider First Line Business Practice Location Address:
107 W PATRIOT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-1489
Provider Business Practice Location Address Fax Number:
814-443-1385
Provider Enumeration Date:
05/01/2006