Provider First Line Business Practice Location Address:
188 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLUMVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16246-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-397-9008
Provider Business Practice Location Address Fax Number:
724-397-9015
Provider Enumeration Date:
10/22/2015