Provider First Line Business Practice Location Address:
943 FOURTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW KENSINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15068-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-335-3334
Provider Business Practice Location Address Fax Number:
724-335-2283
Provider Enumeration Date:
10/13/2022