Provider First Line Business Practice Location Address:
5142 ROUTE 30
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-7613
Provider Business Practice Location Address Fax Number:
724-850-7993
Provider Enumeration Date:
06/10/2006