Provider First Line Business Practice Location Address:
400 LOCUST AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-228-1414
Provider Business Practice Location Address Fax Number:
724-228-8579
Provider Enumeration Date:
12/30/2005