Provider First Line Business Practice Location Address:
1 HUMBERT LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-9905
Provider Business Practice Location Address Fax Number:
724-884-0487
Provider Enumeration Date:
12/19/2016