Provider First Line Business Practice Location Address: 
1000 WATERDAM PLAZA DR STE 240
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MC MURRAY
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15317-5427
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-941-2018
    Provider Business Practice Location Address Fax Number: 
724-941-2093
    Provider Enumeration Date: 
11/23/2021