Provider First Line Business Practice Location Address:
2010 STATE ROUTE 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGONIER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15658-1172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-238-6666
Provider Business Practice Location Address Fax Number:
724-238-6890
Provider Enumeration Date:
01/29/2007