Provider First Line Business Practice Location Address:
9132 SOMERSET PIKE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BOSWELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15531-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-629-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007