Provider First Line Business Practice Location Address:
4 E SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15537-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-652-5822
Provider Business Practice Location Address Fax Number:
724-794-1633
Provider Enumeration Date:
07/02/2006