Provider First Line Business Practice Location Address:
169 S MOUNT VERNON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-3524
Provider Business Practice Location Address Fax Number:
724-438-5218
Provider Enumeration Date:
11/17/2011