Provider First Line Business Practice Location Address:
72 E HIGH 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:
15370-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-6410
Provider Business Practice Location Address Fax Number:
724-852-2624
Provider Enumeration Date:
02/13/2007