Provider First Line Business Practice Location Address:
132 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-853-4501
Provider Business Practice Location Address Fax Number:
724-853-4504
Provider Enumeration Date:
09/15/2009