Provider First Line Business Practice Location Address:
8065 STATE ROUTE 819
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-7507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-925-7299
Provider Business Practice Location Address Fax Number:
724-830-6669
Provider Enumeration Date:
08/15/2006