Provider First Line Business Practice Location Address:
700 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WINDBER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15963-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-467-5984
Provider Business Practice Location Address Fax Number:
814-467-9824
Provider Enumeration Date:
04/13/2006