Provider First Line Business Practice Location Address:
217 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EVANS CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16033-1261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-538-3103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/01/2008