Provider First Line Business Practice Location Address:
445 WEST RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-6387
Provider Business Practice Location Address Fax Number:
814-443-2535
Provider Enumeration Date:
04/16/2007