Provider First Line Business Practice Location Address:
1 NORTHGATE SQ
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:
15601-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-0947
Provider Business Practice Location Address Fax Number:
724-832-0839
Provider Enumeration Date:
09/12/2006