Provider First Line Business Practice Location Address:
95 ENTERPRISE ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15037-2070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-896-9661
Provider Business Practice Location Address Fax Number:
412-896-9807
Provider Enumeration Date:
02/25/2010