Provider First Line Business Practice Location Address:
21 W FAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-438-0336
Provider Business Practice Location Address Fax Number:
724-438-3466
Provider Enumeration Date:
12/21/2006