Provider First Line Business Practice Location Address:
562 SHEARER ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-3960
Provider Business Practice Location Address Fax Number:
724-836-6082
Provider Enumeration Date:
09/19/2007