Provider First Line Business Practice Location Address:
311 WEST UNION STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-8272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006