Provider First Line Business Practice Location Address:
187 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16686-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-684-1255
Provider Business Practice Location Address Fax Number:
814-684-6398
Provider Enumeration Date:
11/19/2012