Provider First Line Business Practice Location Address:
106 PARK STREET
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:
15931-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-472-5270
Provider Business Practice Location Address Fax Number:
814-472-4618
Provider Enumeration Date:
03/06/2007