Provider First Line Business Practice Location Address: 
5750 CENTRE AVENUE
    Provider Second Line Business Practice Location Address: 
CENTER COMMONS BUILDING, SUITE 510
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15206
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-661-1633
    Provider Business Practice Location Address Fax Number: 
412-661-1631
    Provider Enumeration Date: 
03/03/2009