Provider First Line Business Practice Location Address:
114 W MAHONING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUNXSUTAWNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15767-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-776-2145
Provider Business Practice Location Address Fax Number:
814-776-1470
Provider Enumeration Date:
05/03/2012