Provider First Line Business Practice Location Address: 
1099 PITTSBURGH RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
VALENCIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
16059-1934
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
724-687-8120
    Provider Business Practice Location Address Fax Number: 
724-687-8121
    Provider Enumeration Date: 
12/10/2014