Provider First Line Business Practice Location Address:
119 PROFESSIONAL CTR
Provider Second Line Business Practice Location Address:
1265 WAYNE AVENUE, STE. 203
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-463-0286
Provider Business Practice Location Address Fax Number:
724-463-3542
Provider Enumeration Date:
01/16/2009