Provider First Line Business Practice Location Address:
129 DEPAUL CENTER RD
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:
15601-1270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-853-7948
Provider Business Practice Location Address Fax Number:
724-838-1513
Provider Enumeration Date:
08/18/2021