Provider First Line Business Practice Location Address:
1177 S 6TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-9661
Provider Business Practice Location Address Fax Number:
724-463-0922
Provider Enumeration Date:
05/25/2006