Provider First Line Business Practice Location Address:
51 W COLLEGE 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:
15370-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-998-6474
Provider Business Practice Location Address Fax Number:
724-852-3002
Provider Enumeration Date:
08/06/2012