Provider First Line Business Practice Location Address: 
4615 5TH AVE
    Provider Second Line Business Practice Location Address: 
SUITE 100
    Provider Business Practice Location Address City Name: 
PITTSBURGH
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
15213-3661
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
412-682-1259
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/13/2006