Provider First Line Business Practice Location Address:
100 MEDICAL ARTS BLDG
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-543-5919
Provider Business Practice Location Address Fax Number:
724-543-3544
Provider Enumeration Date:
10/12/2007