Provider First Line Business Practice Location Address:
200 VILLAGE DR 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:
15601-3783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-0850
Provider Business Practice Location Address Fax Number:
724-832-1623
Provider Enumeration Date:
09/28/2006