Provider First Line Business Practice Location Address:
12680 PERRY HWY DEPT OF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-8886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-748-5543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2016