Provider First Line Business Practice Location Address:
792 N CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-1096
Provider Business Practice Location Address Fax Number:
814-445-8005
Provider Enumeration Date:
02/18/2008