Provider First Line Business Practice Location Address:
178 HICKORY GRADE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-221-5115
Provider Business Practice Location Address Fax Number:
412-206-0026
Provider Enumeration Date:
01/18/2006