Provider First Line Business Practice Location Address:
1075 S MAIN ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-2112
Provider Business Practice Location Address Fax Number:
724-691-0864
Provider Enumeration Date:
05/03/2006