Provider First Line Business Practice Location Address: 
519 PENN AVE STE 302
    Provider Second Line Business Practice Location Address: 
SUITE 201
    Provider Business Practice Location Address City Name: 
TURTLE CREEK
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15145-2082
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-349-0632
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/23/2006