Provider First Line Business Practice Location Address:
100 MEDICAL ARTS BLDG
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-7135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-543-9194
Provider Business Practice Location Address Fax Number:
724-543-2912
Provider Enumeration Date:
01/30/2006