Provider First Line Business Practice Location Address:
193 W BEAU ST
Provider Second Line Business Practice Location Address:
JEFFERSON COURT PLAZA
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-8322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006