Provider First Line Business Practice Location Address:
95 EAST HIGH STREET
Provider Second Line Business Practice Location Address:
SUITE 407
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:
724-627-4692
Provider Business Practice Location Address Fax Number:
724-852-6313
Provider Enumeration Date:
10/12/2009