Provider First Line Business Practice Location Address:
1821 JEFFERSON ST
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:
15601-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-837-5350
Provider Business Practice Location Address Fax Number:
724-837-5352
Provider Enumeration Date:
02/14/2007