Provider First Line Business Practice Location Address:
250 S CUMBERLAND 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:
15370-0472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-8151
Provider Business Practice Location Address Fax Number:
724-627-9591
Provider Enumeration Date:
08/19/2006