Provider First Line Business Practice Location Address:
1 BRADDOCK ROAD AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-547-5103
Provider Business Practice Location Address Fax Number:
724-547-6147
Provider Enumeration Date:
08/17/2008