Provider First Line Business Practice Location Address:
419 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16125-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-588-3875
Provider Business Practice Location Address Fax Number:
724-588-0284
Provider Enumeration Date:
10/11/2006