Provider First Line Business Practice Location Address:
93 SOUTH PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15331-0680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-288-7503
Provider Business Practice Location Address Fax Number:
724-649-0038
Provider Enumeration Date:
04/30/2015