Provider First Line Business Practice Location Address:
130 BILL GEORGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15370-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-229-0851
Provider Business Practice Location Address Fax Number:
724-229-9252
Provider Enumeration Date:
04/18/2007