Provider First Line Business Practice Location Address:
3133 NEW GERMANY RD
Provider Second Line Business Practice Location Address:
SUITE 62
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-2660
Provider Business Practice Location Address Fax Number:
814-472-2666
Provider Enumeration Date:
05/24/2006