Provider First Line Business Practice Location Address:
BOX 530, ROUTE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-744-4471
Provider Business Practice Location Address Fax Number:
724-744-1214
Provider Enumeration Date:
12/21/2005