Provider First Line Business Practice Location Address:
801 E GREENE ST
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:
15370-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-5399
Provider Business Practice Location Address Fax Number:
724-627-7052
Provider Enumeration Date:
05/29/2008