Provider First Line Business Practice Location Address:
1490 E HIGH 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:
15370-9558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-9489
Provider Business Practice Location Address Fax Number:
724-627-9417
Provider Enumeration Date:
12/02/2005