Provider First Line Business Practice Location Address:
1159 MORRIS 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:
15370-8148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-852-1212
Provider Business Practice Location Address Fax Number:
724-627-5659
Provider Enumeration Date:
07/17/2008