Provider First Line Business Practice Location Address:
12279 ROUTE 30
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
NORTH HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-864-4470
Provider Business Practice Location Address Fax Number:
724-863-7120
Provider Enumeration Date:
08/02/2006