Provider First Line Business Practice Location Address:
301 E 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TARENTUM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15084-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-226-0773
Provider Business Practice Location Address Fax Number:
724-226-0856
Provider Enumeration Date:
05/04/2006