Provider First Line Business Practice Location Address:
313 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-846-4160
Provider Business Practice Location Address Fax Number:
814-419-8218
Provider Enumeration Date:
09/03/2015