Provider First Line Business Practice Location Address:
82 HUFF AVENUE EXT STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-708-7628
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2014