Provider First Line Business Practice Location Address:
1159 6TH 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:
15370-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-852-4222
Provider Business Practice Location Address Fax Number:
724-852-4222
Provider Enumeration Date:
03/16/2007