Provider First Line Business Practice Location Address: 
87 3RD ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CALIFORNIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15419-1127
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-938-7000
    Provider Business Practice Location Address Fax Number: 
724-938-3390
    Provider Enumeration Date: 
04/07/2006