Provider First Line Business Practice Location Address:
221 RIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-5432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-575-5059
Provider Business Practice Location Address Fax Number:
412-593-5116
Provider Enumeration Date:
06/16/2020