Provider First Line Business Practice Location Address:
114 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-864-5017
Provider Business Practice Location Address Fax Number:
724-864-4975
Provider Enumeration Date:
04/11/2013