Provider First Line Business Practice Location Address: 
15 TALL TREES CT
    Provider Second Line Business Practice Location Address: 
UPMC EAST HOSPITAL
    Provider Business Practice Location Address City Name: 
MONROEVILLE
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15146-4866
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-373-4072
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/06/2006