Provider First Line Business Practice Location Address:
793 OLD RTE 119 HWY NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-465-5576
Provider Business Practice Location Address Fax Number:
724-465-6379
Provider Enumeration Date:
11/22/2013