Provider First Line Business Practice Location Address:
5109 ROUTE 30
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-6720
Provider Business Practice Location Address Fax Number:
724-834-3419
Provider Enumeration Date:
03/12/2008