Provider First Line Business Practice Location Address: 
6091 STEUBENVILLE PIKE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MC KEES ROCKS
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15136-1336
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-997-1320
    Provider Business Practice Location Address Fax Number: 
412-494-9579
    Provider Enumeration Date: 
12/19/2006