Provider First Line Business Practice Location Address:
147 LAFAYETTE MANOR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-430-4848
Provider Business Practice Location Address Fax Number:
724-430-1881
Provider Enumeration Date:
05/23/2005