Provider First Line Business Practice Location Address:
6090 ROUTE 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-4180
Provider Business Practice Location Address Fax Number:
724-834-1218
Provider Enumeration Date:
08/22/2007