Provider First Line Business Practice Location Address: 
113 W MCMURRAY RD
    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: 
15317-2427
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-941-3080
    Provider Business Practice Location Address Fax Number: 
724-941-9521
    Provider Enumeration Date: 
01/27/2020