Provider First Line Business Practice Location Address:
FOURTH STREET SQUARE
Provider Second Line Business Practice Location Address:
105 WEST FOURTH STREET
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-6643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-834-7830
Provider Business Practice Location Address Fax Number:
724-834-8395
Provider Enumeration Date:
05/02/2007