Provider First Line Business Practice Location Address:
111 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANONSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-746-1870
Provider Business Practice Location Address Fax Number:
724-746-6752
Provider Enumeration Date:
01/11/2006