Provider First Line Business Practice Location Address:
645 S COLUMBIA AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-2831
Provider Business Practice Location Address Fax Number:
814-443-6624
Provider Enumeration Date:
06/02/2006