Provider First Line Business Practice Location Address: 
2024 E WASHINGTON ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEW CASTLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16101-5354
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-771-1301
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/24/2010