Provider First Line Business Practice Location Address: 
438 PELLIS RD SUITE 101
    Provider Second Line Business Practice Location Address: 
TIM BRIDGES PHD & ASSOCIATES INC
    Provider Business Practice Location Address City Name: 
GREENSBURG
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15601
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-850-7448
    Provider Business Practice Location Address Fax Number: 
724-850-8143
    Provider Enumeration Date: 
11/20/2006