Provider First Line Business Practice Location Address: 
9104 BABCOCK BLVD
    Provider Second Line Business Practice Location Address: 
SUITE 3112
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15237-5818
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-366-3471
    Provider Business Practice Location Address Fax Number: 
412-348-0150
    Provider Enumeration Date: 
10/14/2009