Provider First Line Business Practice Location Address:
4625 STATE ROUTE 136
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:
15601-6415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-205-6981
Provider Business Practice Location Address Fax Number:
724-219-3815
Provider Enumeration Date:
12/12/2007