Provider First Line Business Practice Location Address:
4347 STATE ROUTE 136
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:
15601-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-850-2229
Provider Business Practice Location Address Fax Number:
724-850-2089
Provider Enumeration Date:
12/08/2006