Provider First Line Business Practice Location Address: 
301 1ST ST
    Provider Second Line Business Practice Location Address: 
SUITE 100
    Provider Business Practice Location Address City Name: 
BUTLER
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16001-4756
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-282-4764
    Provider Business Practice Location Address Fax Number: 
724-282-6624
    Provider Enumeration Date: 
07/11/2011