Provider First Line Business Practice Location Address:
997 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-223-3816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006