Provider First Line Business Practice Location Address:
100 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EBENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15931-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-472-9466
Provider Business Practice Location Address Fax Number:
800-398-6217
Provider Enumeration Date:
12/09/2016