Provider First Line Business Practice Location Address:
12381 ROUTE 30 W
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTH HUNTINGDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-864-6560
Provider Business Practice Location Address Fax Number:
724-864-9298
Provider Enumeration Date:
04/27/2007