Provider First Line Business Practice Location Address: 
UNIVERSITY DRIVE C
    Provider Second Line Business Practice Location Address: 
BEHAVIORAL HEALTH-116
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15240
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-360-1290
    Provider Business Practice Location Address Fax Number: 
412-360-2994
    Provider Enumeration Date: 
08/13/2006