Provider First Line Business Practice Location Address:
4893 STATE ROUTE 30
Provider Second Line Business Practice Location Address:
SUITE8
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-600-0607
Provider Business Practice Location Address Fax Number:
724-600-0608
Provider Enumeration Date:
10/11/2006