Provider First Line Business Practice Location Address:
35 S WEST ST
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:
15370-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-4309
Provider Business Practice Location Address Fax Number:
724-627-0726
Provider Enumeration Date:
07/05/2006