Provider First Line Business Practice Location Address:
1215 LONG RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15131-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-664-4717
Provider Business Practice Location Address Fax Number:
412-664-1728
Provider Enumeration Date:
09/25/2006