Provider First Line Business Practice Location Address:
910 PENN AVE
Provider Second Line Business Practice Location Address:
RENAISSANCE MBH CENTER
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15222-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-261-0875
Provider Business Practice Location Address Fax Number:
412-471-6645
Provider Enumeration Date:
10/25/2005