Provider First Line Business Practice Location Address: 
1811 FRANKLIN RUN CT
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15237-1693
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-582-4795
    Provider Business Practice Location Address Fax Number: 
412-366-7048
    Provider Enumeration Date: 
05/17/2006