Provider First Line Business Practice Location Address:
92 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-2311
Provider Business Practice Location Address Fax Number:
724-222-5406
Provider Enumeration Date:
10/30/2026