Provider First Line Business Practice Location Address:
1025 LEWIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15417-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-785-2021
Provider Business Practice Location Address Fax Number:
724-785-6285
Provider Enumeration Date:
04/25/2006