Provider First Line Business Practice Location Address:
4012 JORDAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-375-5534
Provider Business Practice Location Address Fax Number:
724-375-5575
Provider Enumeration Date:
06/12/2007