Provider First Line Business Practice Location Address:
236 ELM DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15370-8265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-852-4032
Provider Business Practice Location Address Fax Number:
724-627-0812
Provider Enumeration Date:
01/17/2008