Provider First Line Business Practice Location Address:
118 S KIMBERLY AVE
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:
15501-2069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-6549
Provider Business Practice Location Address Fax Number:
814-443-4418
Provider Enumeration Date:
02/20/2018