Provider First Line Business Practice Location Address:
75 E MAIDEN ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-554-2191
Provider Business Practice Location Address Fax Number:
724-229-3277
Provider Enumeration Date:
02/27/2007