Provider First Line Business Practice Location Address: 
2055 OLD WASHINGTON PIKE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HEIDELBERG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15106-3741
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-429-3601
    Provider Business Practice Location Address Fax Number: 
412-429-3609
    Provider Enumeration Date: 
08/13/2021