Provider First Line Business Practice Location Address:
1011 OLD SALEM RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-9540
Provider Business Practice Location Address Fax Number:
724-837-3676
Provider Enumeration Date:
01/26/2010