Provider First Line Business Practice Location Address:
1324 STATE ROUTE 168
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
124-859-7377
Provider Business Practice Location Address Fax Number:
724-234-4703
Provider Enumeration Date:
06/11/2019