Provider First Line Business Practice Location Address:
181 W BEAU 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:
15301-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-223-1067
Provider Business Practice Location Address Fax Number:
724-223-1088
Provider Enumeration Date:
06/14/2005