Provider First Line Business Practice Location Address:
225 HUMPHREY RD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-9096
Provider Business Practice Location Address Fax Number:
724-832-2249
Provider Enumeration Date:
03/09/2018