Provider First Line Business Practice Location Address: 
841 HOSPITAL RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
INDIANA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15701-3660
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-469-3440
    Provider Business Practice Location Address Fax Number: 
724-463-3003
    Provider Enumeration Date: 
03/31/2006