Provider First Line Business Practice Location Address: 
501 VALLEYBROOK RD
    Provider Second Line Business Practice Location Address: 
SUITE 106
    Provider Business Practice Location Address City Name: 
MC MURRAY
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15317-3428
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-941-8860
    Provider Business Practice Location Address Fax Number: 
724-941-8955
    Provider Enumeration Date: 
06/10/2009