Provider First Line Business Practice Location Address:
1163 COUNTRY CLUB ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONGAHELA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-258-1126
Provider Business Practice Location Address Fax Number:
724-258-1436
Provider Enumeration Date:
08/29/2006