Provider First Line Business Practice Location Address:
20 MILLER LANE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-852-2727
Provider Business Practice Location Address Fax Number:
724-852-1893
Provider Enumeration Date:
07/19/2006