Provider First Line Business Practice Location Address:
236 ELM DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15370-8265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-379-5816
Provider Business Practice Location Address Fax Number:
724-379-5874
Provider Enumeration Date:
01/17/2012