Provider First Line Business Practice Location Address:
44 E SHIRLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT UNION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17066-1384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-542-2536
Provider Business Practice Location Address Fax Number:
814-542-2584
Provider Enumeration Date:
03/05/2010