Provider First Line Business Practice Location Address:
265 ELM DRIVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-1900
Provider Business Practice Location Address Fax Number:
724-627-1998
Provider Enumeration Date:
10/12/2005