Provider First Line Business Practice Location Address:
115 WOOD DUCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-0615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-6141
Provider Business Practice Location Address Fax Number:
814-443-3155
Provider Enumeration Date:
01/04/2007