Provider First Line Business Practice Location Address: 
1872 HOMEVILLE ROAD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WEST MIFFLIN
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15122
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-466-0670
    Provider Business Practice Location Address Fax Number: 
412-466-1760
    Provider Enumeration Date: 
07/17/2006