Provider First Line Business Practice Location Address:
88 FORT COUCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15241-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-831-1114
Provider Business Practice Location Address Fax Number:
412-831-6965
Provider Enumeration Date:
05/27/2005