Provider First Line Business Practice Location Address:
917 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-443-2933
Provider Business Practice Location Address Fax Number:
814-443-4695
Provider Enumeration Date:
06/22/2005