Provider First Line Business Practice Location Address:
1070 OLD NATIONAL PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15333-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-632-6801
Provider Business Practice Location Address Fax Number:
724-632-6312
Provider Enumeration Date:
10/24/2007