Provider First Line Business Practice Location Address:
4501 ADMIRAL PEARY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-4332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-0495
Provider Business Practice Location Address Fax Number:
814-472-0572
Provider Enumeration Date:
06/14/2006