Provider First Line Business Practice Location Address:
1520 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15066-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-843-3800
Provider Business Practice Location Address Fax Number:
714-843-4799
Provider Enumeration Date:
09/22/2005