Provider First Line Business Practice Location Address: 
314 MIDLAND AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CARNEGIE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15106-2335
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
814-505-5749
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/16/2016