Provider First Line Business Practice Location Address:
1150 7TH STREET
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:
15370-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-2336
Provider Business Practice Location Address Fax Number:
724-627-2341
Provider Enumeration Date:
07/20/2011